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Direct oral anticoagulants more effective than low-molecular-weight heparin for venous thrombo-embolism in cancer: an updated meta-analysis of randomized trials

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Abstract

In the recent past, low-molecular-weight heparin (LMWH) was the first choice in the treatment of cancer related venous thrombo-embolism (VTE). Evidence supporting the preferential use of direct anticoagulants (DOACs) in patients with cancer, instead, is less robust so far. We therefore aimed to assess in an updated meta-analysis of randomized controlled trials whether the use of DOACs may be associated with a more favorable profile when compared to LMWH. We performed a meta-analysis of RCTs enrolling patients with VTE and cancer. We assessed Mantel–Haenszel pooled estimates of risk ratios (RRs) and 95% CIs for recurrence of VTE, major bleeding, and mortality comparing subjects treated with DOACs with those with LMWH. After study selection, three RCTs (HOKUSAI-Cancer, SELECT-D and ADAM-VTE) were included for the analysis with an overall population of 1739 patients. DOACs patients had a lower incidence of 6-month recurrent VTE when compared to LMWHs (RR 0.56, 95% CI 0.40–0.79; p < 0.001). Incidence of major bleeding was not significantly different between DOACs and LMWH treated patients (RR 1.56, 95% CI 0.95–2.47, p = n.s.), and mortality rates were comparable (RR 1.03, 95% CI 0.91–2.47, p = n.s.). In a meta-analysis of RCTs therapy with DOACs was superior to LMWH in terms of efficacy and lower recurrence of VTE with a comparable safety profile in terms of bleeding events and complications.

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Authors and Affiliations

  1. Department of Medical & Surgical Sciences, University of Foggia, Foggia, Italy

    Natale Daniele Brunetti, Lucia Tricarico, Michele Correale & Francesco Santoro

  2. Cardiology Department, Ospedale San Paolo, Bari, Italy

    Luisa De Gennaro

  3. Cardiology Department, Ospedali Riuniti University Hospital, Foggia, Italy

    Riccardo Ieva

  4. GVM Care & Research, Santa Maria Hospital, Bari, Italy

    Matteo Di Biase

Authors
  1. Natale Daniele Brunetti
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  2. Lucia Tricarico
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  3. Michele Correale
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  4. Luisa De Gennaro
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  5. Francesco Santoro
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  6. Riccardo Ieva
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  7. Matteo Di Biase
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Correspondence to Natale Daniele Brunetti.

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Brunetti, N.D., Tricarico, L., Correale, M. et al. Direct oral anticoagulants more effective than low-molecular-weight heparin for venous thrombo-embolism in cancer: an updated meta-analysis of randomized trials. J Thromb Thrombolysis 50, 305–310 (2020). https://doi.org/10.1007/s11239-019-01974-y

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